Healthcare Provider Details

I. General information

NPI: 1346490422
Provider Name (Legal Business Name): THERESA M WURTZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 SW OAKLEY AVE
TOPEKA KS
66606-1995
US

IV. Provider business mailing address

5401 SW 7TH ST
TOPEKA KS
66606-2330
US

V. Phone/Fax

Practice location:
  • Phone: 785-233-1730
  • Fax: 785-234-3493
Mailing address:
  • Phone: 785-273-2252
  • Fax: 785-215-8862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7277
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: